Provider Demographics
NPI:1417484551
Name:MIHALICK, KAITLIN MARTHA (AUDIOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:MARTHA
Last Name:MIHALICK
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MARTHA
Other - Last Name:DERRENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 INDEPENDENCE PARKWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5197
Mailing Address - Country:US
Mailing Address - Phone:757-547-9714
Mailing Address - Fax:757-547-0725
Practice Address - Street 1:1037 CHAMPIONS WAY
Practice Address - Street 2:STE 100
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3764
Practice Address - Country:US
Practice Address - Phone:757-547-9714
Practice Address - Fax:757-547-0725
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001650231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist